程序性死亡受体1与肝癌相关性及程序性死亡受体1单抗治疗肝癌疗效的Meta分析

Correlation between programmed cell death 1 and hepatocellular carcinoma and efficacy of programmed cell death 1 monoclonal antibody in treatment of hepatocellular carcinoma:a Meta analysis

目的系统评价外周血程序性死亡受体1(PD-1)与肝癌的相关性及PD-1单抗治疗肝癌的疗效和安全性。方法通过计算机在CNKI、维普、万方、PubMed和CBM等数据库中检索关于PD-1与肝癌相关性及PD-1单抗治疗肝癌的公开发表的文献。由3名研究者对文献质量进行评价和资料提取,对符合质量标准的文献进行Meta分析。结果本研究共纳入9篇文献,其中PD-1与肝癌相关性的研究5篇,肝癌组246例,健康组170例;PD-1单抗治疗肝癌的研究4篇,接受PD-1单抗治疗的患者共852例。Meta分析结果显示,外周血中CD4^(+)PD-1、CD8^(+)PD-1高表达均与肝癌有关(P﹤0.01)。PD-1单抗组肝癌患者的客观缓解率(ORR)高于对照组,但差异无统计学意义(ES=0.18,95%CI:0.15~0.20,P﹥0.05);PD-1单抗组肝癌患者的疾病控制率(DCR)高于对照组,差异有统计学意义(SMD=0.64,95%CI:0.59~0.69,P﹤0.05);PD-1单抗组肝癌患者的不良反应发生率低于对照组,差异有统计学意义(SMD=0.24,95%CI:0.59~0.69,P﹤0.05)。结论外周血PD-1表达水平与肝癌有关,PD-1单抗对肝癌具有明显的治疗效果,亦具有较好的安全性。

Objective To systematically evaluate the correlation between peripheral blood programmed cell death 1(PD-1)and hepatocellular carcinoma(HCC)and the efficacy and safety of PD-1 monoclonal antibody(mAb)in the treatment of HCC.Method CNKI,VIP,Wanfang,PubMed and CBM databases were used to check the published articles about the correlation between PD-1 and HCC and the treatment of HCC with PD-1 mAb.Three researchers evaluated the quality of literatures and extracted the data,and conducted this Meta-analysis on the research literature that met the quality standards.Result A total of 9 articles were included in this study,including 5 studies on the correlation between PD-1 and HCC,246 cases in HCC group and 170 cases in healthy group.There were 4 studies on the treatment of HCC with PD-1 mAb,and 852 patients were treated with PD-1 mAb.Meta analysis showed that the high expression of CD4^(+)PD-1 and CD8^(+)PD-1 in peripheral blood is related to HCC(P<0.01).The objective response rate(ORR)of patients with HCC in the PD-1 mAb group was higher than that in the control group,but the difference was not statistically significant(ES=0.18,95%CI:0.15-0.20,P>0.05).The disease control rate(DCR)of PD-1 mAb group was higher than that of the control group,and the difference was statistically significant(SMD=0.64,95%CI:0.59-0.69,P<0.05).The incidence of adverse reactions in PD-1 mAb group was lower than that of the control group,and the difference was statistically significant(SMD=0.24,95%CI:0.59-0.69,P<0.05).Conclusion PD-1 in peripheral blood is associated with HCC.PD-1 mAb has obvious efficacy in treatment of HCC and has good safety.